Get the free Kadcyla (ado-) Precertification Request
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MEDICARE FORM
For Medicare Advantage Part B:
PHONE: 18665030857
FAX:
18442687263TMHerceptin (trastuzumab), Herceptin Select
(trastuzumab and hyaluronidaseoysk), Helium
(trastuzumabpkrb), Kayla (adotrastuzumab),
Kanji
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How to fill out kadcyla ado- precertification request
How to fill out kadcyla ado- precertification request
01
Obtain the Kadcyla Ado-Precertification Request form from the appropriate source.
02
Fill out the patient's demographic information including name, date of birth, address, and insurance information.
03
Provide the healthcare provider's information including name, contact information, and NPI number.
04
Complete the section detailing the patient's diagnosis, medical history, and current treatment plan.
05
Include any relevant supporting documentation such as lab results, imaging studies, or progress notes.
06
Submit the completed form along with any supporting documentation to the designated channel for precertification requests.
Who needs kadcyla ado- precertification request?
01
Patients who have been prescribed Kadcyla and require precertification for insurance coverage.
02
Healthcare providers who are seeking approval from insurance companies for the use of Kadcyla in their patients.
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